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Jagtiani P, Young T, Ahmed W, Devarajan A, Hickman ZL, Jones S. Prevalence of Acute Alcohol Use in Traumatic Brain Injury Patients During the COVID-19 Pandemic: A Retrospective Analysis From Queens, New York. Cureus 2024; 16:e58928. [PMID: 38800166 PMCID: PMC11122664 DOI: 10.7759/cureus.58928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Background This study investigates the impact of New York's relaxed alcohol consumption policies during the coronavirus disease (COVID-19) pandemic on alcohol-related traumatic brain injuries (TBIs) among patients admitted to a Level 1 trauma center in Queens. Given the limited research available, this study critically explores the link between public health policies and trauma care. It aims to address a significant gap in the literature and highlight the implications of alcohol regulations during global health emergencies. Methodology A retrospective analysis was conducted among trauma patients from 2019 to 2021. The study period was divided into the following three periods: pre-lockdown (March 7, 2019, to July 31, 2019), lockdown (March 7, 2020, to July 31, 2020), and post-lockdown (March 7, 2021, to July 31, 2021). Data on demographics, injury severity, comorbidities, and outcomes were collected. The study focused on assessing the correlation between New York's alcohol policies and alcohol-related TBI admissions during these periods. Results A total of 1,074 admissions were analyzed. The study found no significant changes in alcohol-positive patients over the full calendar years of 2019, 2020, and 2021 (42.65%, 38.91%, and 31.16% respectively; p = 0.08711). Specifically, during the lockdown period, rates of alcohol-positive TBI patients remained unchanged, despite the relaxed alcohol policies. There was a decrease in alcohol-related TBI admissions in 2021 compared to 2020 during the lockdown period. Conclusions Our study concludes that New York's specific alcohol policies during the COVID-19 pandemic were not correlated with an increase in alcohol-related TBI admissions. Despite the relaxation of alcohol consumption laws, there was no increase in alcohol positivity among TBI patients. The findings suggest a complex relationship between public policies, alcohol use, and trauma during pandemic conditions, indicating that factors other than policy relaxation might influence alcohol-related trauma incidences.
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Affiliation(s)
- Pemla Jagtiani
- School of Medicine, State University of New York Downstate Health Sciences University, Queens, USA
| | - Tirone Young
- Medical School, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Wasil Ahmed
- Medical School, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alex Devarajan
- Medical School, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Zachary L Hickman
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Salazar Jones
- Neurological Surgery, Mount Sinai Hospital, New York, USA
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2
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Manasa M, Yeates EO, Grigorian A, Barrios C, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Juillard C, Garber K, Cryer H, Tillou A, Burruss S, Penaloza-Villalobos L, Lin A, Figueras RA, Coimbra R, Brenner M, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Tay-Lasso E, Chinn J, Naaseh A, Leung A, Grabar C, Nahmias J. The Effect of 2019 Coronavirus Stay-at-Home Order on Geriatric Trauma Patients in Southern California. Am Surg 2023; 89:6053-6059. [PMID: 37347234 DOI: 10.1177/00031348221124329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND California issued stay-at-home (SAH) orders to mitigate COVID-19 spread. Previous studies demonstrated a shift in mechanisms of injuries (MOIs) and decreased length of stay (LOS) for the general trauma population after SAH orders. This study aimed to evaluate the effects of SAH orders on geriatric trauma patients (GTPs), hypothesizing decreased motor vehicle collisions (MVCs) and LOS. METHODS A post-hoc analysis of GTPs (≥65 years old) from 11 level-I/II trauma centers was performed, stratifying patients into 3 groups: before SAH (1/1/2020-3/18/2020) (PRE), after SAH (3/19/2020-6/30/2020) (POST), and a historical control (3/19/2019-6/30/2019) (CONTROL). Bivariate comparisons were performed. RESULTS 5486 GTPs were included (PRE-1756; POST-1706; CONTROL-2024). POST had a decreased rate of MVCs (7.6% vs 10.6%, P = .001; vs 11.9%, P < .001) and pedestrian struck (3.4% vs 5.8%, P = .001; vs 5.2%, P = .006) compared with PRE and CONTROL. Other mechanisms of injury, LOS, mortality, and operations performed were similar between cohorts. However, POST had a lower rate of discharge to skilled nursing facility (SNF) (20% vs 24.5%, P = .001; and 20% vs 24.4%, P = .001). CONCLUSION This retrospective multicenter study demonstrated lower rates of MVCs and pedestrian struck for GTPs, which may be explained by decreased population movement as a result of SAH orders. Contrary to previous studies on the generalized adult population, no differences in other MOIs and LOS were observed after SAH orders. However, there was a lower rate of discharge to SNF, which may be related to a lack of resources due to the COVID-19 pandemic, and thus potentially negatively impacted recovery of GTPs.Keywords.
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Affiliation(s)
- Morgan Manasa
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Eric O Yeates
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Areg Grigorian
- Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | - Cristobal Barrios
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Galinos Barmparas
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Margulies
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Catherine Juillard
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Kent Garber
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Henry Cryer
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Areti Tillou
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Sigrid Burruss
- Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | | | - Ann Lin
- Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | | | - Raul Coimbra
- Riverside University Health System, Moreno Valley, CA, USA
| | - Megan Brenner
- Riverside University Health System, Moreno Valley, CA, USA
| | - Todd Costantini
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA, USA
| | - Jarrett Santorelli
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA, USA
| | - Terry Curry
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA, USA
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA
| | - Walter L Biffl
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Kathryn B Schaffer
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Thomas K Duncan
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Casey Barbaro
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Graal Diaz
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | | | - Erika Tay-Lasso
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Justine Chinn
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Ariana Naaseh
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Amanda Leung
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Christina Grabar
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
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3
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Donnelly M, Grigorian A, Inaba K, Nguyen N, de Virgilio C, Schubl S, Paladugu A, Swentek L, Nahmias J. Trends in mass shootings in the United States (2013-2021): A worsening American epidemic of death. Am J Surg 2023; 226:197-201. [PMID: 37032237 DOI: 10.1016/j.amjsurg.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Mass shootings represent a significant problem in the United States (US). This study aimed to examine trends in mass shootings in the US over time. METHODS Retrospective mass shooting data (1/2013-12/2021) were collected from the Gun Violence Archive. A scatterplot was constructed showing predicted (extrapolated from 2013 to 2019) versus actual total mass shootings in 2020 and 2021. Multivariate linear regressions were performed to evaluate trends in mass shootings over time, associated with gun law strength. RESULTS Mass shooting incidents, injuries, and deaths in 2020 and 2021 exceeded extrapolations from previous years. When comparing 2019 to 2020, stronger gun laws were associated with decreased monthly mass shooting deaths. For these same strong gun law states, monthly mass shooting deaths decreased when comparing 2019 to 2021 and comparing 2020 to 2021. CONCLUSIONS US mass shootings have increased over the past decade. Stronger gun laws appear associated with fewer monthly mass shooting-related deaths. Firearm-related legislation may at least partially, curtail the worsening of this substantial "American problem" of mass shootings.
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Affiliation(s)
- Megan Donnelly
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
| | - Areg Grigorian
- University of Southern California, Department of Surgery, Los Angeles, CA, USA.
| | - Kenji Inaba
- University of Southern California, Department of Surgery, Los Angeles, CA, USA.
| | - Ninh Nguyen
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
| | | | - Sebastian Schubl
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
| | - Anushka Paladugu
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
| | - Lourdes Swentek
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA. https://twitter.com/jnahmias1
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Jakob DA, Lewis M, Benjamin ER, Haltmeier T, Schnüriger B, Exadaktylos AK, Demetriades D. Pre-injury stimulant use in isolated severe traumatic brain injury: effect on outcomes. Eur J Trauma Emerg Surg 2023; 49:1683-1691. [PMID: 36066583 PMCID: PMC9446589 DOI: 10.1007/s00068-022-02095-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to assess the impact of pre-injury stimulant use (amphetamine, cocaine, methamphetamine and/or ecstasy) on outcomes after isolated severe traumatic brain injury (TBI). METHODS Retrospective 2017 TQIP study, including adult trauma patients (≥16 years old) who underwent drug and alcohol screening on admission and sustained an isolated severe TBI (head AIS ≥3). Patients with significant extracranial trauma (AIS ≥3) were excluded. Epidemiological and clinical characteristics, procedures and outcome variables were collected. Patients with isolated stimulant use were matched 1:1 for age, gender, mechanism of injury, head AIS and overall comorbidities, with patients with negative toxicology and alcohol screen. Outcomes in the two groups were compared with univariable and multivariable regression analysis. RESULTS 681 patients with isolated TBI and stimulant use were matched with 681 patients with negative toxicology and alcohol screen. The incidence of hypotension and CGS <9 was similar in the two groups. In multivariable regression analysis, stimulant use was not independently associated with mortality (OR 0.95, 95% CI 0.61-1.49). However, stimulant use was associated with longer hospital length of stay (HLOS) (RC 1.13, 95%CI 1.03-1.24). CONCLUSION Pre-injury stimulant use is common in patients admitted for severe TBI, but was not independently associated with mortality when compared to patients with negative toxicology. However, stimulant use was associated with a significant longer HLOS.
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Affiliation(s)
- Dominik Andreas Jakob
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County, University of Southern California Medical Center, University of Southern California, Los Angeles, CA 90033 USA
- Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, Freiburgstrasse 16C, 3010 Bern, Switzerland
| | - Meghan Lewis
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County, University of Southern California Medical Center, University of Southern California, Los Angeles, CA 90033 USA
| | - Elizabeth Robinson Benjamin
- Division of Trauma and Acute Care Surgery, Department of Surgery, Grady Health System, Emory University, Atlanta, GA 30327 USA
| | - Tobias Haltmeier
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Beat Schnüriger
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Demetrios Demetriades
- Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County, University of Southern California Medical Center, University of Southern California, Los Angeles, CA 90033 USA
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5
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Donnelly M, Kuza C, Sargent B, Swentek L, de Virgilio C, Grigorian A, Schubl S, Nahmias J. Firearm Violence Surrounding the COVID-19 Pandemic: A Reopening Phenomenon. J Surg Res 2023; 285:168-175. [PMID: 36680877 PMCID: PMC9808419 DOI: 10.1016/j.jss.2022.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/15/2022] [Accepted: 12/24/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Past research has demonstrated a "reopening phenomenon" of increased firearm violence associated with the initial lifting of coronavirus disease 2019 (COVID-19) pandemic-related restrictions after the first wave. Now, with widespread societal reemergence from stay-at-home measures, we hypothesize another spike in firearm violence in the United States (US). Thus, the purpose of this study was to evaluate the trends in firearm violence before and after extensive community reopenings during the COVID-19 pandemic. METHODS The Gun Violence Archive was utilized to collect data on daily firearm violence incidents, injuries, and deaths as well as on types of firearm violence. Mann-Whitney U-tests were performed for trends and types of firearm violence "before" (12/14/20-4/9/21) versus "after" (4/10/21-7/31/21) widespread societal reopening in the US. Additional analyses also sought to compare the after reopening time-period to historical data (2017-2020) of similar calendar dates, to better control for possible annual/seasonal variation. RESULTS Median daily firearm violence incidents (153 versus 176, P < 0.001), injuries (89 versus 121, P < 0.001) and deaths (54 versus 58, P < 0.001) increased from before versus after reopening. Compared to all historical years, in the after reopening time-period there were consistent increases in total as well as mass shooting incidents/injuries/deaths (all P < 0.05). CONCLUSIONS Firearm violence incidents, injuries, and deaths increased after societal reemergence from the COVID-19 pandemic. In addition, there has been an increase in mass shootings despite a relative lull initially brought on by the pandemic. This suggests the "reopening phenomenon" has worsened an already substantial national firearm epidemic.
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Affiliation(s)
- Megan Donnelly
- Division of Trauma, Department of Surgery, University of California, Irvine, Burns and Surgical Critical Care, Orange, California
| | - Catherine Kuza
- Department of Anesthesiology, University of Southern California, Los Angeles, California
| | - Brynn Sargent
- Division of Trauma, Department of Surgery, University of California, Irvine, Burns and Surgical Critical Care, Orange, California
| | - Lourdes Swentek
- Division of Trauma, Department of Surgery, University of California, Irvine, Burns and Surgical Critical Care, Orange, California
| | | | - Areg Grigorian
- Department of Surgery, University of Southern California, Los Angeles, California
| | - Sebastian Schubl
- Division of Trauma, Department of Surgery, University of California, Irvine, Burns and Surgical Critical Care, Orange, California
| | - Jeffry Nahmias
- Division of Trauma, Department of Surgery, University of California, Irvine, Burns and Surgical Critical Care, Orange, California.
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6
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O'Neill KM, Dodington J, Gawel M, Borrup K, Shapiro DS, Gates J, Gregg S, Becher RD. The effect of the COVID-19 pandemic on community violence in Connecticut. Am J Surg 2023; 225:775-780. [PMID: 36253316 PMCID: PMC9540704 DOI: 10.1016/j.amjsurg.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Natural disasters may lead to increases in community violence due to broad social disruption, economic hardship, and large-scale morbidity and mortality. The effect of the COVID-19 pandemic on community violence is unknown. METHODS Using trauma registry data on all violence-related patient presentations in Connecticut from 2018 to 2021, we compared the pattern of violence-related trauma from pre-COVID and COVID pandemic using an interrupted time series linear regression model. RESULTS There was a 55% increase in violence-related trauma in the COVID period compared with the pre-COVID period (IRR: 1.55; 95%CI: 1.34-1.80; p-value<0.001) driven largely by penetrating injuries. This increase disproportionately impacted Black/Latinx communities (IRR: 1.61; 95%CI: 1.36-1.90; p-value<0.001). CONCLUSION Violence-related trauma increased during the COVID-19 pandemic. Increased community violence is a significant and underappreciated negative health and social consequence of the COVID-19 pandemic, and one that excessively burdens communities already at increased risk from systemic health and social inequities.
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Affiliation(s)
- Kathleen M O'Neill
- Division of General Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, Department of Surgery, New Haven, CT, 06520, USA; Investigative Medicine Program, Yale School of Medicine, Yale Graduate School of Arts and Sciences, New Haven, CT, 06510, USA.
| | - James Dodington
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, 06510, USA; Violence Intervention Program, Yale New Haven Hospital, USA.
| | - Marcie Gawel
- Violence Intervention Program, Yale New Haven Hospital, USA.
| | - Kevin Borrup
- Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, 06106, USA; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, 06032, USA.
| | - David S Shapiro
- Department of Surgery, Saint Francis Hospital & Medical Center, USA; Associate Professor of Surgery University of Connecticut School of Medicine & Frank L. Netter Schools of Medicine, USA.
| | - Jonathan Gates
- Department of Surgery, Hartford Healthcare Hartford Hospital, USA.
| | - Shea Gregg
- Trauma, Burns and Surgical Critical Care, Bridgeport Hospital, USA.
| | - Robert D Becher
- Division of General Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, Department of Surgery, New Haven, CT, 06520, USA.
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Rao S, Glavis-Bloom J, Kakish D, Tran-Harding K, Chow DS, Nguyentat M, Yeates EO, Nahmias J, Houshyar R. Impact of easing COVID-19 safety measures on trauma computed tomography imaging volumes. Emerg Radiol 2023; 30:27-32. [PMID: 36307571 PMCID: PMC9616698 DOI: 10.1007/s10140-022-02096-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/20/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has led to substantial disruptions in healthcare staffing and operations. Stay-at-home (SAH) orders and limitations in social gathering implemented in spring 2020 were followed by initial decreases in healthcare and imaging utilization. This study aims to evaluate the impact of subsequent easing of SAH on trauma volumes, demand for, and turnaround times for trauma computed tomography (CT) exams, hypothesizing that after initial decreases, trauma volumes have increased as COVID safety measures have been reduced. METHODS Patient characteristics, CT imaging volumes, and turnaround time were analyzed for all adult activated emergency department trauma patients requiring CT imaging at a single Level-I trauma center (1/2018-2/2022) located in the sixth most populous county in the USA. Based on COVID safety measures in place in the state of California, three time periods were compared: baseline (PRE, 1/1/2018-3/19/2020), COVID safety measures (COVID, 3/20/2020-1/25/2021), and POST (1/26/2021-2/28/2022). RESULTS There were 16,984 trauma patients across the study (PRE = 8289, COVID = 3139, POST = 5556). The average daily trauma patient volumes increased significantly in the POST period compared to the PRE and COVID periods (13.9 vs. 10.3 vs. 10.1, p < 0.001), with increases in both blunt (p < 0.001) and penetrating (p = 0.002) trauma. The average daily number of trauma CT examinations performed increased significantly in the POST period compared to the PRE and COVID periods (56.7 vs. 48.3 vs. 47.6, p < 0.001), with significant increases in average turnaround time (47 min vs. 31 and 37, p < 0.001). CONCLUSION After initial decreases in trauma radiology volumes following stay-at-home orders, subsequent easing of safety measures has coincided with increases in trauma imaging volumes above pre-pandemic levels and longer exam turnaround times.
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Affiliation(s)
- Sriram Rao
- Department of Radiological Sciences, University of California Irvine, Orange, CA, USA
| | - Justin Glavis-Bloom
- Department of Radiological Sciences, University of California Irvine, Orange, CA, USA
| | - David Kakish
- Department of Radiological Sciences, University of California Irvine, Orange, CA, USA
| | - Karen Tran-Harding
- Department of Radiological Sciences, University of California Irvine, Orange, CA, USA
| | - Daniel S Chow
- Department of Radiological Sciences, University of California Irvine, Orange, CA, USA
| | - Michael Nguyentat
- Department of Radiological Sciences, University of California Irvine, Orange, CA, USA
| | - Eric O Yeates
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Roozbeh Houshyar
- Department of Radiological Sciences, University of California Irvine, Orange, CA, USA.
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Vo AT, Patton T, Peacock A, Larney S, Borquez A. Illicit Substance Use and the COVID-19 Pandemic in the United States: A Scoping Review and Characterization of Research Evidence in Unprecedented Times. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148883. [PMID: 35886734 PMCID: PMC9317093 DOI: 10.3390/ijerph19148883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023]
Abstract
We carried out a scoping review to characterize the primary quantitative evidence addressing changes in key individual/structural determinants of substance use risks and health outcomes over the first two waves of the COVID-19 pandemic in the United States (US). We systematically queried the LitCovid database for US-only studies without date restrictions (up to 6 August 2021). We extracted quantitative data from articles addressing changes in: (a) illicit substance use frequency/contexts/behaviors, (b) illicit drug market dynamics, (c) access to treatment and harm reduction services, and (d) illicit substance use-related health outcomes/harms. The majority of 37 selected articles were conducted within metropolitan locations and leveraged historical timeseries medical records data. Limited available evidence supported changes in frequency/behaviors/contexts of substance use. Few studies point to increases in fentanyl and reductions in heroin availability. Policy-driven interventions to lower drug use treatment thresholds conferred increased access within localized settings but did not seem to significantly prevent broader disruptions nationwide. Substance use-related emergency medical services’ presentations and fatal overdose data showed a worsening situation. Improved study designs/data sources, backed by enhanced routine monitoring of illicit substance use trends, are needed to characterize substance use-related risks and inform effective responses during public health emergencies.
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Affiliation(s)
- Anh Truc Vo
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Correspondence:
| | - Thomas Patton
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (T.P.); (A.B.)
| | - Amy Peacock
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Sarah Larney
- Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, QC H3C 3J7, Canada;
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, San Diego, CA 92093, USA; (T.P.); (A.B.)
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Ruhi-Williams P, Yeates EO, Grigorian A, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Juillard C, Garber K, Cryer H, Tillou A, Burruss S, Penaloza-Villalobos L, Lin A, Figueras RA, Coimbra R, Brenner M, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Chinn J, Naaseh A, Leung A, Grabar C, Nahmias J. Adolescent Trauma During the COVID Pandemic: Just Like Adults, Children, or Someone Else? Am Surg 2022; 88:2429-2435. [PMID: 35583103 PMCID: PMC9127450 DOI: 10.1177/00031348221101475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
COVID-19 stay-at-home (SAH) orders were impactful on adolescence, when social
interactions affect development. This has the potential to change adolescent
trauma. A post-hoc multicenter retrospective analysis of adolescent
(13-17 years-old) trauma patients (ATPs) at 11 trauma centers was performed.
Patients were divided into 3 groups based on injury date: historical control
(CONTROL:3/19/2019-6/30/2019, before SAH (PRE:1/1/2020-3/18/2020), and after SAH
(POST:3/19/2020-6/30/2020). The POST group was compared to both PRE and CONTROL
groups in separate analyses. 726 ATPs were identified across the 3
time periods. POST had a similar penetrating trauma rate compared to both PRE
(15.8% vs 13.8%, P = .56) and CONTROL (15.8% vs 14.5%,
P = .69). POST also had a similar rate of suicide attempts
compared to both PRE (1.2% vs 1.5%, P = .83) and CONTROL (1.2%
vs 2.1%, P = .43). However, POST had a higher rate of drug
positivity compared to CONTROL (28.6% vs 20.6%, P = .032), but
was similar in all other comparisons of alcohol and drugs to PRE and POST
periods (all P > .05). Hence ATPs were affected differently
than adults and children, as they had a similar rate of penetrating trauma,
suicide attempts, and alcohol positivity after SAH orders. However, they had
increased drug positivity compared to the CONTROL, but not PRE group.
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Affiliation(s)
- Perisa Ruhi-Williams
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Eric O Yeates
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Areg Grigorian
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA.,Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Galinos Barmparas
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Margulies
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Catherine Juillard
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Kent Garber
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Henry Cryer
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Areti Tillou
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Sigrid Burruss
- Department of Surgery, 4608Loma Linda University, Loma Linda, CA, USA
| | | | - Ann Lin
- Department of Surgery, 4608Loma Linda University, Loma Linda, CA, USA
| | | | - Raul Coimbra
- Department of Surgery, 4608Loma Linda University, Loma Linda, CA, USA.,472028Riverside University Health System Medical CenterUniversity, Moreno Valley, CA, USA
| | - Megan Brenner
- University of California, Riverside/Riverside University Health System Department of Surgery, Moreno Valley, CA, USA
| | - Todd Costantini
- Department of Surgery, 8784University of California, San Diego (UCSD), San Diego, CA, USA
| | - Jarrett Santorelli
- Department of Surgery, 8784University of California, San Diego (UCSD), San Diego, CA, USA
| | - Terry Curry
- Department of Surgery, 8784University of California, San Diego (UCSD), San Diego, CA, USA
| | - Diane Wintz
- Department of Surgery, 21380Sharp Memorial Hospital, San Diego, CA, USA
| | - Walter L Biffl
- Trauma Department, 24146Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Kathryn B Schaffer
- Trauma Department, 24146Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Thomas K Duncan
- Department of Surgery, 25352Ventura County Medical Center, Ventura, CA, USA
| | - Casey Barbaro
- Department of Surgery, 25352Ventura County Medical Center, Ventura, CA, USA
| | - Graal Diaz
- Department of Surgery, 25352Ventura County Medical Center, Ventura, CA, USA
| | - Arianne Johnson
- Cottage Health Research Institute, 22854Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Justine Chinn
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Ariana Naaseh
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Amanda Leung
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Christina Grabar
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
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10
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Emigh B, Clark DH, Schellenberg M. The impact of coronavirus 2019 on trauma. Curr Opin Anaesthesiol 2022; 35:154-159. [PMID: 35045003 DOI: 10.1097/aco.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The relationship between trauma and the ongoing global coronavirus 2019 (COVID-19) pandemic is still largely unclear. This comprehensive review of recent studies examining overall trauma volumes, mechanisms of injury, and outcomes after trauma during the COVID-19 pandemic was performed to better understand the impact of the pandemic on trauma patients. RECENT FINDINGS In the early stages of the pandemic, the overall volumes of patients seen in many major trauma centers had decreased; however, these rates largely returned to historical baselines after the cessation of stay-at-home orders. An increasing proportion of trauma patients were injured by penetrating mechanisms during the pandemic. Being a victim of interpersonal violence was an independent risk factor for COVID-19 infection. In two studies utilizing propensity score-matched analysis among trauma patients, COVID-19 infection was associated with a five- to sixfold increase in mortality risk as compared to uninfected patients. SUMMARY Consequences of the COVID-19 pandemic include increased financial stressors, job loss, mental illness, and illegal drug use, all of which are known risk factors for trauma. This is particularly true among vulnerable patient populations such as racial minority groups and low socioeconomic status patients. To lessen the impact of COVID-19 on trauma patients, increased awareness of the problem and heightened emphasis on injury prevention must be made.
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Affiliation(s)
- Brent Emigh
- Division of Acute Care Surgery, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, California, USA
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11
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Yeates EO, Grigorian A, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Juillard C, Garber K, Cryer H, Tillou A, Burruss S, Penaloza-Villalobos L, Lin A, Figueras RA, Coimbra R, Brenner M, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Chinn J, Naaseh A, Leung A, Grabar C, Nahmias J. Decreased hospital length of stay and intensive care unit admissions for non-COVID blunt trauma patients during the COVID-19 pandemic. Am J Surg 2022; 224:90-95. [PMID: 35219493 PMCID: PMC8863305 DOI: 10.1016/j.amjsurg.2022.02.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 01/08/2023]
Abstract
Background The COVID-19 pandemic overwhelmed hospitals, forcing adjustments including discharging patients earlier and limiting intensive care unit (ICU) utilization. This study aimed to evaluate ICU admissions and length of stay (LOS) for blunt trauma patients (BTPs). Methods A retrospective review of COVID (3/19/20-6/30/20) versus pre-COVID (3/19/19-6/30/19) BTPs at eleven trauma centers was performed. Multivariable analysis was used to identify risk factors for ICU admission. Results 12,744 BTPs were included (6942 pre-COVID vs. 5802 COVID). The COVID cohort had decreased mean LOS (3.9 vs. 4.4 days, p = 0.029), ICU LOS (0.9 vs. 1.1 days, p < 0.001), and rate of ICU admission (22.3% vs. 24.9%, p = 0.001) with no increase in complications or mortality compared to the pre-COVID cohort (all p > 0.05). On multivariable analysis, the COVID period was associated with decreased risk of ICU admission (OR = 0.82, CI 0.75–0.90, p < 0.001). Conclusions BTPs had decreased LOS and associated risk of ICU admission during COVID, with no corresponding increase in complications or mortality.
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Affiliation(s)
- Eric O Yeates
- University of California, Irvine (UCI), Department of Surgery, Orange, CA, USA.
| | - Areg Grigorian
- University of California, Irvine (UCI), Department of Surgery, Orange, CA, USA; University of Southern California (USC), Department of Surgery, Los Angeles, CA, USA.
| | - Morgan Schellenberg
- University of Southern California (USC), Department of Surgery, Los Angeles, CA, USA.
| | | | - Galinos Barmparas
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, USA.
| | - Daniel Margulies
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, USA.
| | - Catherine Juillard
- University of California, Los Angeles (UCLA), Department of Surgery, Los Angeles, CA, USA.
| | - Kent Garber
- University of California, Los Angeles (UCLA), Department of Surgery, Los Angeles, CA, USA.
| | - Henry Cryer
- University of California, Los Angeles (UCLA), Department of Surgery, Los Angeles, CA, USA.
| | - Areti Tillou
- University of California, Los Angeles (UCLA), Department of Surgery, Los Angeles, CA, USA.
| | - Sigrid Burruss
- Loma Linda University, Department of Surgery, Loma Linda, CA, USA.
| | | | - Ann Lin
- Loma Linda University, Department of Surgery, Loma Linda, CA, USA.
| | | | - Raul Coimbra
- Loma Linda University, Department of Surgery, Loma Linda, CA, USA; Riverside University Health System Medical Center, Moreno Valley, CA, USA.
| | - Megan Brenner
- University of California, Riverside/Riverside University Health System Department of Surgery, Moreno Valley, CA, USA.
| | - Todd Costantini
- University of California, San Diego (UCSD), Department of Surgery, San Diego, CA, USA.
| | - Jarrett Santorelli
- University of California, San Diego (UCSD), Department of Surgery, San Diego, CA, USA.
| | - Terry Curry
- University of California, San Diego (UCSD), Department of Surgery, San Diego, CA, USA.
| | - Diane Wintz
- Sharp Memorial Hospital, Department of Surgery, San Diego, CA, USA.
| | - Walter L Biffl
- Scripps Memorial Hospital La Jolla, Trauma Department, La Jolla, CA, USA.
| | - Kathryn B Schaffer
- Scripps Memorial Hospital La Jolla, Trauma Department, La Jolla, CA, USA.
| | - Thomas K Duncan
- Ventura County Medical Center, Department of Surgery, Ventura, CA, USA.
| | - Casey Barbaro
- Ventura County Medical Center, Department of Surgery, Ventura, CA, USA.
| | - Graal Diaz
- Ventura County Medical Center, Department of Surgery, Ventura, CA, USA.
| | - Arianne Johnson
- Santa Barbara Cottage Hospital, Cottage Health Research Institute, Santa Barbara, CA, USA.
| | - Justine Chinn
- University of California, Irvine (UCI), Department of Surgery, Orange, CA, USA.
| | - Ariana Naaseh
- University of California, Irvine (UCI), Department of Surgery, Orange, CA, USA.
| | - Amanda Leung
- University of California, Irvine (UCI), Department of Surgery, Orange, CA, USA.
| | - Christina Grabar
- University of California, Irvine (UCI), Department of Surgery, Orange, CA, USA.
| | - Jeffry Nahmias
- University of California, Irvine (UCI), Department of Surgery, Orange, CA, USA.
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12
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Abstract
PURPOSE The COVID-19 pandemic resulted in increased penetrating trauma and decreased length of stay (LOS) amongst the adult trauma population, findings important for resource allocation. Studies regarding the pediatric trauma population are sparse and mostly single-center. This multicenter study examined pediatric trauma patients, hypothesizing increased penetrating trauma and decreased LOS after the 3/19/2020 stay-at-home (SAH) orders. METHODS A multicenter retrospective analysis of trauma patients ≤ 17 years old presenting to 11 centers in California was performed. Demographic data, injury characteristics, and outcomes were collected. Patients were divided into three groups based on injury date: 3/19/2019-6/30/2019 (CONTROL), 1/1/2020-3/18/2020 (PRE), 3/19/2020-6/30/2020 (POST). POST was compared to PRE and CONTROL in separate analyses. RESULTS 1677 patients were identified across all time periods (CONTROL: 631, PRE: 479, POST: 567). POST penetrating trauma rates were not significantly different compared to both PRE (11.3 vs. 9.0%, p = 0.219) and CONTROL (11.3 vs. 8.2%, p = 0.075), respectively. POST had a shorter mean LOS compared to PRE (2.4 vs. 3.3 days, p = 0.002) and CONTROL (2.4 vs. 3.4 days, p = 0.002). POST was also not significantly different than either group regarding intensive care unit (ICU) LOS, ventilator days, and mortality (all p > 0.05). CONCLUSIONS This multicenter retrospective study demonstrated no difference in penetrating trauma rates among pediatric patients after SAH orders but did identify a shorter LOS.
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13
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Yeates EO, Nahmias J. Response to Wyatt et al.'s comment on "Changes in traumatic mechanisms of injury in Southern California related to COVID-19: Penetrating trauma as a second pandemic". J Trauma Acute Care Surg 2021; 91:e38. [PMID: 33852562 PMCID: PMC8218980 DOI: 10.1097/ta.0000000000003241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Eric O Yeates
- Department of Surgery, University of California, Irvine, Orange, CA
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